Project Abstract Motivation: This is a competing renewal of our successful project, Rapid Robust Pediatric MRI, R01 EB009690. MRI offers superb soft tissue contrast for children, without the ionizing radiation and cancer risk of CT. However, MRI use has been limited due to long exams, low spatial resolution, and motion-artifacts. Thus, MRI often requires prolonged anesthesia with breath-holds and attendant risk; hence, children often lack the bene?ts of cross-sectional imaging altogether or are exposed to ionizing radiation. The previous project addressed these concerns by creating a dedicated pediatric imaging system. Highly par- allel, high-SNR 3T receive coil arrays were designed and constructed speci?cally for pediatric body imaging. The high SNR was used to accelerate scans reconstructed with a combination of parallel imaging, new mo- tion correction algorithms, compressed sensing (CS), and higher dimensional imaging. The resulting system is now being used extensively in clinical practice, signi?cantly reducing anesthesia depth and duration, and has markedly increased our MRI utilization. Key technologies have been or are now being commercialized with GE Healthcare, including the pediatric receive array, CS, 4D ?ow, full-Fourier single-shot T2-weighted scanning, and coil compression. Siemens has licensed ?ve of our patents, implemented them in work-in-progress packages, and productized our coil compression and our ESPIRiT coil sensitivity estimation. Philips has licensed three of our patents. This ensures broad impact. Approach: Despite signi?cant progress and reduced anesthesia depth and duration, patient cooperation re- mains the main limitation to eliminate anesthesia in all pediatric body MRI exams. Many children will cooperate for several minutes, but then ?dget and get out of the scanner. Others are content until acoustic noise agi- tates them. Therefore the major emphasis now is greater exam execution speed, comprehensive elimination of acoustic noise, and increased robustness, particularly to contrast agent injection. The project has three interrelated development aims, validated by clinical studies. Aim 1 will enable fast 2D imag- ing for quiet T2 and quiet low-distortion diffusion weighted imaging. A second aim is to develop free-breathing 3D contrast-enhanced and diffusion-weighted imaging that is silent and motion-robust. The third aim will enable au- tomated, smart scanning to speed the exam execution and adaptive protocols to increase the exam robustness. The impact of all of these developments in the clinic will then be assessed to assess the resulting reduction of anesthesia. Signi?cance: This work will lead to fast, robust, broadly-applicable pediatric MRI protocols with less anes- thesia, making MRI safer, cheaper, and more available to children. MRI will be transformed into a workhorse modality, reducing CT radiation burden. The techniques will facilitate wide application in the community setting and permit new MRI applications, for both pediatric and adult diseases.